Massage therapists are told by many clients to “go deeper” or “I want deep tissue”—yet, what does deep tissue really mean?

Deep tissue massage is often offered as a specialty or add-on treatment, and today, there seem to be as many definitions of this work as there are therapists.

Different teachers present different standards and interpretations within entry-level schooling. As a teaching assistant in 2002, I heard one of my respected peers state, “Sometimes you need to hurt your clients.” I didn’t know how to receive this statement at first, but grimaced as I witnessed the demo client receiving obviously painful touch.

Years later, when I began teaching, I vowed to never present deep tissue work in that manner. These days, I teach a mindful approach to this type of work. Some peers agree with my approach while others scoff, indicating their approaches are deeper and therefore more effective. Regardless of personal opinion, communication is needed to understand what your client interprets as deep tissue massage.

If the massage industry is confused about deep tissue, it stands to figure that our clients are too. Ultimately, it is the therapist’s professional responsibility to communicate with clients in order to understand their interpretation of the term and clarify any misperceptions.

Understanding How Deep Tissue Benefits the Client

When a client requests deep tissue, a therapist should ask the client what this term means to them.

What are their expectations of receiving a deep tissue massage?

What benefits does the client foresee or perceive with this type of bodywork?

Providing a few minutes prior to the session connecting on expectations of the work will facilitate a healthy session and avoid unnecessary confusion. What follows are several possible interpretations of the term deep tissue.

Deep pressure application. To many clients, the phrase deep tissue means applying pressure to the body to an extent of a sensation felt.

How deep is deep enough? Some teachers describe a proper depth of pressure is that depth in which the client’s skin turns red initially yet fades to normal skin color by session end. Other teachers suggest a client’s skin remaining red the following day indicates proper depth of pressure. Still others suggest to provide more depth until a wall of tissue prevents further entry. Yet other teachers say to provide depth until you feel the first level of client resistance, which may be felt as twitching or shifting of tissues.

Applying pressure can be performed safely by a therapist to avoid injury. Using a variety of manual tools, such as fingertips, finger pads, knuckles, soft fist, forearms and elbows (aside from thumb pressure) will provide the therapist a healthy assortment of tools with which to apply deeper pressure. We as therapists should never hurt ourselves for a client. It is appropriate to inform a client that they can be referred to another therapist if their pressure demands cannot be met.

Bodywork that legitimately hurts. Some clients genuinely believe in the “no pain, no gain” mentality with massage; that a massage is only effective if it causes pain. Upon a pain response, the pituitary gland sends endorphin and encephalin chemicals to the injury site. These chemicals make an area feel better, which may be why many clients enjoy receiving initially painful touch.

The effects of pain-reducing chemicals can be profound and long-lasting in many people. Further, clients do not realize that creating a pain response also causes the body to guard and hold unnecessary pressure in other areas. This is a classic example of short-term gain, long-term loss that reduces the therapeutic effects of massage overall for this client. It is imperative that the therapist helps these clients see the potential harm in receiving painful massage. “Do no harm” needs to be remembered as our duty as therapists. Our work is meant to create ease, balance and wellness, not to disrupt nor disturb the body.

• Bodywork that hurts so good. Many clients understand the difference between pain and discomfort in session. The phrase hurts so good usually implies there is mild discomfort felt, yet not enough pain to elicit a non-verbal cue of guarding a region. The person may hold greater tension momentarily during the technique stroke yet release that tension upon stroke’s end.

Many schools teach this as an optimal therapy zone in which a client is experiencing sensations indicating release is occurring. The affected area usually turns red and warm quickly with this pressure, as inflammation may onset rapidly.

Remember, a client may say a massage stroke feels good but their body may indicate otherwise. Be sure to assess nonverbal signs of communication, which include twitching, grimacing, flinching, holding breath, changes in facial expression and guarding of a region. It is the responsibility of the therapist to ensure massage techniques are safe and effective, regardless of if a client feels they can tough it out.

• Specific work upon painful spots. Some clients request that you address certain areas that hurt. Perhaps you recognize some clients saying such phrases as, “Dig in here”; “It hurts there”; and “Stay there.” Such phrases indicate a client wants you to remain in the area and eliminate pain felt and sourced there.

When a therapist begins touching painful areas, they may begin to employ pain-management methods in sessions. Use of hydrotherapy, including ice, heat or both in combination; employing tools such as cups, scraping tools, taping and oils of various types; and incorporating breathwork and slowing down the pace of sessions are all ways to effectively reduce pain responses felt by clients.

• Working attachments of muscles near bones. Focusing on specific attachments of muscles at bony landmarks can be an effective way to facilitate relaxation of muscle tendons, which affects the overall muscle. Most massage schools have presented cross fiber friction strokes as a staple technique when addressing muscle tendons. Multi-directional friction has been shown in recent research to be even more effective at accomplishing goals of releasing muscle/tendon tension.

• Therapeutic bodywork (versus “relaxing” Swedish). Many clients and therapists make an assumption in conversation that a massage is either relaxing or therapeutic, and that these are mutually exclusive goals. This is an error in judgement, as relaxation can be among the most profound therapeutic benefits of massage. Calming the nervous system is very therapeutic and allows the body to reset itself and relieve tension patterns internally.

Any activity that relaxes the mind will relax the body. This is why yoga, qi gong, tai chi and any other means to create relaxation will benefit the physical body. As nervous tension releases, all other tissues release and respond favorably toward health. Massage can be one of the many methods to therapeutically relax the body.

• Rolfing Structural Integration. Some clients have received formal Rolfing sessions from certified Rolfing practitioners who have completed specialized training at the Rolf Institute. This consumer is savvy enough to understand that a therapist claiming to be a Rolfing practitioner understands and views the human body holistically and that their session is not merely a deep Swedish massage.

Structural Integration is a term used by many therapists who have learned massage techniques and assessment methods from Rolfing practitioners, yet who have not attended the formal Rolfing training.

Long, slow, medium-to-deep strokes, beginning superficially and going deeper with each stroke application, is the fundamental technique approach to structural integration.

Many instructors add a client activation component to a stroke, meaning a client moves a limb while a stroke is performed by the therapist. There are scores of modality names for this adaptation of traditional structural integration.

If a client requests Rolfing, refer them to a certified Rolfer. If a client requests Structural Integration, perform this technique if you have been trained accordingly; otherwise, refer.

Understanding the Client’s Needs Benefits the Therapist

Which definition of deep tissue most resonates with you as a therapist? Perhaps the answer to this question will determine many facets of your business. Your continuing education choices can be made clearer by understanding how you want to work with the human body, for example, and you will select modalities and approaches that align with your deep tissue perspective.

Also, determining what deep tissue means to you might make it easier to determine your market. This will save much time and resources related to advertising.

Finally, this clear perception of deep tissue will allow you to better express the effectiveness of massage efforts. The ability to communicate how a client’s body responded to a session will help enhance the perceived value of the session in the client’s mind.

Healthy communication with a client will involve comprehending their definition for our esoteric term deep tissue. Once you and your client are on the same page, treatment efforts improve immensely, with the client benefiting from their desired and needed therapy. As you learn how to read the client’s body, massage efforts become easier and goals are achieved more efficiently.

About the Author

Jimmy Gialelis, LMT, BCTMB, is owner of Advanced Massage Arts & Education in Tempe, Arizona. He is a National Certification Board for Therapeutic Massage & Bodywork-approved provider of continuing education, and teaches “Professional Ethics for LMTs” and many other CE classes. He is a regular contributor to MASSAGE Magazine, and his articles include “ “Massage Improves Quality of Life for the Cerebral Palsy Patient.”